Research & Reviews: Journal of Dental Sciences
Menue-ISSN: 2320-7949 and p-ISSN: 2322-0090
e-ISSN: 2320-7949 and p-ISSN: 2322-0090
Department of Operative Dentistry, Baqai Dental College, BMU Karachi, Pakistan
Received Date: 26/05/2016; Accepted Date: 21/10/2016; Published Date: 28/10/2016
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Objective: The objective of the study was to determine the Knowledge, Attitude and Practice of areca nut, gutka and smoking amongst school children aged between 12 to 18 years. Methods: The present cross sectional study was conducted in August 2014 – December 2014. The study was approved by the ethical committee of Baqai Medical University. A cluster sampling technique was used and a total of eight private schools located in urban areas of Karachi were selected. A total of 1000 school children aged between 12 to 18 years were selected and a list of the children participated from grade eight to ten were obtained from the respective school authorities. A self-administered questionnaire was designed comprised of 14 closed ended questions about Knowledge, Attitude and Practice towards consumption of areca nut, gutka and tobaccos smoking that were filled by the participants. Descriptive statistics were obtained and mean, standard deviation, frequency and percentages were calculated. Chi- square test was done to assess the association of gender with areca nut consumption. Data was analyzed by using SPSS version 20. P- value<0.05. Result: Sixty two (83.8%) were boys and twelve (16.2%) were girls who agreed in consumption of tobacco product. Four ninety seven (76.5%) boys and 156 (23.9%) girls were aware of the harmful effect of utilization of areca nut, gutka and nicotine smoking. Two hundred and thirty three (85.3%) boys and 40 (14.7%) girls tried to quit these habits. Conclusion: The present study concluded that school going children lack Knowledge, Attitude and Practice regarding consumption of areca nut, gutka and tobacco smoking.
Areca nut, Awareness, Chewing habits, Cigarette smoking, Gutka, School children, Tobacco Smoking
Areca nut is chewed by approximately 600 million people worldwide [1] and is the fourth most common psychoactive substance used globally [2]. Areca nut chewing, by itself or in combination with scents, condiments or sweeteners is an accepted practice in parts of the Western Pacific and many South and South East Asian countries, including India and Pakistan [3-5]. Shah et al. [6] reported that 72.7% of the school children were daily habitual users of areca nut. Areca-nut is marketed in the form of the sweetened areca-nut (locally known as sweet supari) to target young children. Chewing of the areca-nut usually starts early in life leading to multiple health hazards in adulthood. Childhood and adolescence are the times when people try this form of sweetened areca nut and start using the products [7]. Adolescence and young adulthood are the times when people are most susceptible, more vulnerable and more predisposed by marketing than adults and if their friends or their siblings chew, then they are even more eager to try themselves [8]. School children often offer the packets to each other instead of candies but most of them do not know that these harmless looking sachets are actually very hazardous to their oral and general health [7].
Gutka is a preparation of crushed tobacco, areca nut, lime, catechu and flavoring agent [9]. The habit of consuming gutka starts as a teenager in higher secondary school and is believed to carry on to adulthood and then later in life confined to the elderly [10]. In Pakistan, there is 8.5 to 10 times increased risk of oral cancer because of chewing tobacco, eating pan, gutka and betel nut [11]. Kamal et al. reported that, in Karachi only, 21% men and 19.3% females are suffering from oral cavity cancer, 7% of primary school children consumed gutka and 96% of women living on coastal areas of Karachi consumed gutka while they also breastfeed their children [12]. Media or electronic advertisements and too much marketing of gutka in small eye catching and low cost sachets have greatly enhanced the sales of these products [9].
Tobacco use and especially cigarette smoking is a major public health problem among students not only in developed countries but also developing countries. The Global Youth Tobacco Survey reported that no difference was observed in cigarette smoking prevalence between boys and girls in 58% of the countries [13-15]. Several factors have been attributed to the use of tobacco products by students and these includes the perceptions that smoking enhanced one's image, relieved boredom and helped in reduction of tension [16]. Mohan et al. [15] reported use of tobacco by fathers and friends, adults, poor educational background and availability to pocket money as major contributors to tobacco use by students. In Pakistan, a survey of students' reported similar factors like smoking by peers, family members and spending free time outside home as contributing to cigarette smoking [17].
In this era of modern globalization, young people are adopting behavior patterns that may vary from country to country. Gutka and tobacco companies are advertising their products by mass media techniques and target the youth of the world [18].
Therefore the present study was conducted primarily to determine the Knowledge, Attitude and Practice of areca nut, gutka and smoking amongst school children aged between 12 to 18 years.
The present cross sectional study was conducted in August 2014 – December 2014. The study was approved by the ethical committee of Baqai Medical University. A cluster sampling technique was used and a total of eight private schools located in urban areas of Karachi were selected. A total of 1000 school children aged between 12 to 18 years were selected and a list of the children participated from grade eight to ten were obtained from the respective school authorities and then children were randomly selected from each grade school children. The sample size was calculated by taking the prevalence rate and computed using the Epi Infoversion 6 statistical package at 95% confidence interval and α=5%.
Students of age range between 12 -18 years who consume areca nut, gutka and tobacco smoking were included in this study. Students aged above 18 and below 12 were excluded from study. A self-administered questionnaire was designed comprised of 14 closed ended questions about Knowledge, attitude and practice towards consumption of areca nut, gutka and tobacco smoking were filled by the participants .A written application for permission to start the survey attached with the questionnaire was submitted to the respective school principals. All the available students were requested to participate in the study and consent was taken from guardians/teachers of all the participants.
Descriptive statistics were obtained and mean, standard deviation, frequency and percentages were calculated. Chi- square test was done to assess the association of gender with areca nut consumption. Data was analyzed by using SPSS version 20 P-value<0.05.
A total of 772 out of 1000 students participated in the study out of which 590 (76.4%) were boys and 182 (23.5%) were girls. Mean and standard deviation regarding attitude and practice towards consumption of areca nut, gutka and tobacco smoking was (1.61 ± 0.516) as shown in (Table 1).
Table 1. Showed descriptive statistics of knowledge, attitude and practice of areca nut, gutka and smoking in children.
| Variables | Mean ± SD | Min – Max | P- value |
|---|---|---|---|
| Do you /have you ever used tobacco products? | 1.36 ± 0.409 | 0 – 3 | 0.001 |
| How many do you/did you smoke? | 0.18 ± 0.546 | 0 – 3 | 0.005 |
| Do you or have you ever chewed tobacco pan, gutka and supari? | 1.61 ± 0.516 | 0 – 3 | 0.237 |
| How many do you/did you chew? | 0.51 ± 0.763 | 0 – 4 | 0.549 |
| At which age you started this habit? | 1.02 ± 1.318 | 0 – 4 | 0.065 |
| Why do you use these products? | 0.90 ± 1.181 | 0 – 4 | 0.582 |
| Have you ever tried to quit these habits? | 0.72 ± 0.756 | 0 – 2 | 0.000 |
| Do you know harmful effects of these products? | 1.23 ± 0.590 | 0 – 3 | 0.866 |
| Do your parents know about your habit? | 1.72 ± 0.845 | 0 – 3 | 0.504 |
| From where you get these products? | 2.18 ± 0.871 | 0 – 4 | 0.001 |
| How many times do you brush your teeth? | 1.76 ± 0.703 | 0 – 4 | 0.002 |
| What do you use to clean your teeth? | 1.13 ± 0.398 | 0 –3 | 0.837 |
| Do you use dental floss? | 1.63 ± 0.493 | 0 – 2 | 0.036 |
Sixty two (83.8%) boys and 12 (16.2%) of girls agreed in consumption of tobacco product. Four ninety seven (76.5%) boys and 156 (23.9%) girls were aware of the harmful effect of utilization of areca nut, gutka and nicotine smoking. Two hundred and thirty three (85.3%) boys and 40 (14.7%) girls tried to quit these habits (Table 2). One hundred and sixty seven (76.7%) boys and 51 (23.4%) of the girls reported to have a habit of chewing areca nut and gutka 1 to 5 times a day. Fifty five (90.2%) boys and 6 (9.8%) girls reported smoking 1 to 5 times a day (Table 3).
Table 2. Frequency of consumption of areca nut, gutka and tobacco smoking in children.
| Variables | Boys | Girls | Total |
|---|---|---|---|
| Do you/have you ever used tobacco products? | 62 (83.8%) | 12 (16.2%) | 74 (100%) |
| Do you or have you ever chewed tobacco pan, gutka and supari? | 215 (76.5%) | 66 (23.5%) | 281 (100%) |
| Have you ever tried to quit these habits? | 233 (85.3%) | 40 (14.7%) | 273 (100%) |
| Do you know harmful effects of these products? | 497 (76.1%) | 156 (23.9%) | 653 (100%) |
| Do your parents know about your habit? | 314 (76.4%) | 97 (23.6%) | 411 (100%) |
| Do you use dental floss? | 196 (71.8%) | 77 (28.2%) | 273 (100%) |
Table 3. Showed frequency of daily consumption of areca nut, gutka and tobacco smoking in children.
| Variables | Boys | Girls | ||||||
|---|---|---|---|---|---|---|---|---|
| 1 – 5 times | 6 – 10 times | 11 – 15 times | 16 – 20 times | 1 – 5 times | 6 – 10 times | 11 – 15 times | 16 – 20 times | |
| How many do you/did you smoke? | 55 (90.2%) | 21 (87.5%) | 11 (100%) | 0 (0%) | 6 (9.8%) | 3 (12.5%) | 0 (0%) | 0(0%) |
| How many do you/did you chew? | 16 (76.6%) | 39 (69.6%) | 11 (78.6%) | 5 (100%) | 51 (23.4%) | 17 (30.4%) | 3 (21.4%) | 0(0%) |
Areca nut, gutka and smoking are widely prevalent and it deserves special attention because of its attractiveness and social acceptance [19]. The present study was conducted to determine Knowledge, Attitude and Practice of areca nut, gutka and smoking amongst school children aged between 12 to 18 years. Although this habit is equally distributed among all population age groups, a generally higher proportion of school going children are observed of consuming areca nut on daily basis in one or the other form. Oakley et al. [18] reported that 27% of school children habitually consume areca nut. Pobutsky et al. [19] reported having the highest prevalence (63%) of consuming areca nut in high school children. The present study reported that a total of 74 students amongst which 62 (83.8%) were boys and 12 (16.2%) girls consumed tobacco products, gutka and areca nut. Another cross sectional study conducted in government school of Mahmoudabad and Chanesar Goth, Karachi which reported that 97.3% consumed tobacco products amongst which 167 (62%) was boys and 165 (44.6%) was girls [6]. The sources of information about the areca nut/tobacco smoking were; observing in the community, prompting by friends and family influence [20]. The present study reported that 193 (80.4%) boys and 47 (19.6%) girls buy these products from shops located nearby their homes and 118 (68.6%) boys and 54 (31.4%) girls from friends. Krishna D et al. [17] reported that amongst 65.75% of the boys first came to know from their friends whereas 66.7% of the girls came to know from their family members.
Regarding the knowledge and awareness of harmful effects of chewing habits, Singh et al. [21] showed that 2842 (99.2%) boys and 934 (99.5%) girls were aware that tobacco use is harmful and similar proportions disliked it. Gupta et al. [22] reported that amongst 1365 (91.4%) students claimed to have knowledge about harmful effects of tobacco. The present study reported that 497 (76.1%) boys and 156 (23.9%) girls were aware of the health hazards of the consumption of areca nut, gutka and tobacco smoking. Two hundred and thirty three (85.3%) boys and 40 (14.7%) girls tried to get rid of this habit in this study following the acquisition of awareness regarding damaging effects. More than 80% among both boys and girls were using the substances with full knowledge of their family [6]. Three hundred and fourteen (76.4%) boys and 97 (23.6%) girls responded in this study that their parents are aware of their habits.
The most common reason put forth by users was peer pressure, followed by advertisements, general stress, and academic pressure. The academic pressure was more amongst private school students whereas peer pressure was more amongst government school students [23].
The present study reported that 103 (76.3%) boys and 32 (23.7%) girls consumed these products because of good taste and 90 (81.8%) boys and 21 (18.9%) girls just for fun. Qureshi et al. [24] reported that 70.4% students consumed because of pleasant taste and 17.7% were influenced by advertisements.
The present study concluded that school going children lack knowledge, attitude and practice regarding consumption of areca nut, gutka and tobacco smoking. It was also reported that most of the school children consumed just for fun and its good taste. Therefore efforts should be made to discourage younger generation not to begin these habits and to recognize their potential health hazards. The Government of Pakistan should impose a ban on all sorts of advertisements for marketing of these products and should keep a check on the local shops selling these products. Furthermore awareness programmes should be planned to educate school children, parents, teachers and general public to discourage such habits.